Basic Information
| Provider Information | |||||||||
| NPI: | 1801306501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 PERRY ST | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197829920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3389 COUNTY ROAD 2425 | ||||||||
| Address2: | |||||||||
| City: | STRYKER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435579418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194282322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2017 | ||||||||
| LastUpdateDate: | 10/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 001147 | 01 | OH | LICENSE | OTHER |